Abstract: Background　Gout is a common crystal-induced arthritis.Although treat-to-target therapies for gout have been reported in many recent studies，the effectiveness of such therapies in China is not satisfactory.Objective　To explore the prevalence and associated factors of achieving target uric acid（UA）level in gout patients.Methods　113 patients with a clinical diagnosis of gout were randomly sampled from Northern Jiangsu People's Hospital，Affiliated Hospital to Yangzhou University from September 2016 to January 2019，and all patients received 6 months of gout treatment up to standard.The clinical data were collected by questionnaire，and the patients were examined in laboratory and imaging.According to the UA standard of patients after treatment，the patients were divided into compliance group and non compliance group.Multiple Logistic regression analysis was used to explore the influencing factors of UA standard of gout patients.Results　Out of 113 patients，105 completed the survey.The rate of achieving target UA was 65.7%（69/105）.Both the UA level and urate crystal deposition decreased after treatment（P<0.05）.Those who achieved target UA level had higher rates of normal BMI，no tophus and no hyperlipidemia，disease duration greater than 5 years，increased / similar drinking volume，no less than 2 000 ml of drinking water，exercising less than 5 times a week，and normal liver function compared with those who did not（P<0.05）.Multivariate Logistic regression analysis showed that abnormal liver functions（OR=9.641），increased / similar drinking volume（OR=13.970），no less than 2 000 ml of drinking water（OR=0.189）and exercise frequency greater than 5 times a week is not less than five times a week（OR=3.421）were associated with the rate of achieving target UA level（P<0.05），while different uric acid-lowering drug therapies were not associated with it（χ2=1.357，P=0.716）.Conclusion　The treat-to-target therapy can significantly reduce the content of urate crystal in the gouty joints and surrounding tissues.Abnormal liver function，increased / similar drinking volume，and exercising 5 or more times a week are independent factors associated with decreased effectiveness of treat-to-target therapy while no less than 2 000 ml of drinking water is associated with increased effectiveness of treat-to-target therapy.

Key words: Gout, Treat to target, Root cause analysis, Uric acid

摘要： 背景　痛风是一种常见的晶体性关节炎性疾病，近年来，国内外关于痛风达标治疗的研究较多，但目前我国痛风达标治疗的效果并不理想。目的　探究痛风患者达标治疗后血尿酸（UA）的达标情况及其影响因素。方法　2016年9月—2019年1月选取扬州大学附属苏北人民医院临床诊断为痛风的患者113例为研究对象，患者均接受6个月的痛风达标治疗。采用痛风患者达标治疗影响因素的调查表收集其临床资料，并对患者进行实验室及影像学检查。根据治疗后患者UA达标情况，将患者分为达标组与未达标组。采用多因素Logistic回归分析探索痛风患者UA达标情况的影响因素。结果　113例患者中，共有105例患者完成了调查。达标治疗6个月后，痛风患者的UA达标率为65.7%（69/105）；治疗后痛风患者的尿酸盐沉积量、UA水平较治疗前减低（P<0.05）。达标组的BMI正常、无痛风石、病程>5年、无高脂血症、饮酒量比以前增加/跟以前差不多、饮水量≥2 000 ml、运动情况<5次/周、肝功能正常所占比例高于未达标组（P<0.05）。多因素Logistic回归分析结果显示，肝功能异常（OR=9.641）、饮酒量比以前增加/跟以前差不多（OR=13.970）、饮水量≥2 000 ml（OR=0.189）、运动情况≥5次/周（OR=3.421）是UA达标情况的影响因素（P<0.05）。不同降UA药物对痛风患者UA达标率比较，差异无统计学意义（χ2=1.357，P=0.716）。结论　达标治疗可明显减少痛风发作关节数及降低周围组织中尿酸盐沉积量；肝功能异常、饮酒量比以前增加/跟以前差不多和运动次数≥5次/周是UA达标情况的独立危险因素，饮水量>2 000 ml是UA达标情况的保护因素。

关键词: 痛风, 达标治疗, 影响因素分析, 尿酸